775 - Incident mental health diagnoses in children following traumatic brain injury

Publication Number: 775.5501

Kalyn C.. Jannace, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Ian S. Sorensen, Henry M Jackson Foundation for the Advancement of Military Medicine, Inc, Bethesda, MD, United States; Sarah Prabhakar, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States; Rebecca N. Schulz, Henry M. Jackson Foundation, Rockville, MD, United States; Elizabeth J. Hisle-Gorman, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Bethesda, MD, United States

Background: Serious injuries are traumatic events that increase mental healthcare risk in children and youth. Traumatic brain injury (TBI) contributes significantly to disability and mortality with upwards of 500,000 emergency room visits and 60,000 TBI hospitalizations annually. TBI has been associated with mental health sequelae in children and youth, yet it is unclear if increased risk is related to brain injury or the experience of a traumatic event.

Objective: Quantify the association between TBI and mental health outcomes in children 2-18 years of age

Design/Methods: Electronic health record data from the Military Health System Data Repository (MDR) identified children, including their demographic data, ages 2 to 18 experiencing a serious physical injury, defined using ICD-9 codes (ICD), between 2005 and 2015. Injuries were categorized as TBI injury or non-TBI purely physical injury. Logistic regression models calculated the odds ratios (OR) and 95% confidence intervals (CIs) for the following diagnoses in the 12 months post-injury: posttraumatic stress disorder (PTSD), anxiety, depression, attention-deficit disorder (ADHD) and any of these diagnoses. Adjusted models included race/ethnicity, parent’s military rank, sex, and age.

Results: During the study period, 63,089 children experienced an injury. Most children were male (60%), white (49%), senior enlisted service members’ children (66%), mean 10 years old (SD: 5), with approximately 73% experiencing a TBI. In the 12 months post-injury, around 7% of children received a mental health diagnosis, with less than 1% PTSD, and approximately 3% with anxiety, 2% with depression, and 4% with ADHD. Prior to adjustment, any diagnosis (OR: 1.13, 95% CI: 1.05-1.21), anxiety (1.19, 1.06-1.34), and depression (1.59, 1.39-1.83). After adjustment, only odds of depression remained significantly higher (1.18, 1.02-1.36) among children with TBI compared to children with other serious injuries.

Conclusion(s): These preliminary findings suggest increased depression risk among children following TBI, but do not find increased risk for other mental health conditions previously associated with TBI.